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Updated: Aug 28, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Safety of left atrial appendage closure in heart failure patients
Subrat Das1, Marta Lorente-Ros2, Lingling Wu3
1Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA.
Insights
Left atrial appendage closure (LAAC) is safe for preventing strokes in heart failure (HF) patients with atrial fibrillation (AF). While cardiac outcomes were similar, noncardiac complications were higher in HF patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Nonvalvular atrial fibrillation (AF) significantly increases stroke risk, particularly in patients with concomitant heart failure (HF).
- Left atrial appendage closure (LAAC) offers an alternative stroke prevention strategy, but its safety in HF patients requires further investigation.
- Anticoagulation, a standard treatment, is underutilized in this high-risk population.
Purpose of the Study:
- To evaluate the safety and outcomes of Left Atrial Appendage Closure (LAAC) in patients with heart failure (HF) compared to those without HF.
- To assess inpatient mortality, cardiac complications, and noncardiac complications following LAAC in a large, national cohort.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016-2018 to identify patients undergoing LAAC (WATCHMAN device insertion) using ICD-10 codes.
- Stratified the study population into two groups: those with HF and those without HF.
- Compared key outcomes including inpatient mortality, cardiac, and noncardiac complications between the two groups using statistical analyses (p < 0.05).
Main Results:
- A total of 34,385 LAAC procedures were analyzed, with 8,530 (24.8%) performed in patients with HF.
- No significant differences were observed in inpatient mortality or cardiac complications between HF and non-HF groups.
- Patients with HF experienced higher rates of noncardiac complications, including acute kidney injury and respiratory failure.
Conclusions:
- Left atrial appendage closure (LAAC) appears to be a safe procedural option for stroke prevention in patients with heart failure (HF) and atrial fibrillation (AF).
- While cardiac safety is comparable to non-HF patients, increased vigilance for noncardiac complications in HF patients undergoing LAAC is warranted.
- Further long-term follow-up studies are necessary to fully ascertain the long-term efficacy and safety profile of LAAC in this population.
Introduction:
Left atrial appendage closure (LAAC) is an intervention aimed at stroke prevention in nonvalvular atrial fibrillation (AF). There is a three-fold increased risk of stroke in patients with concomitant presence of AF and heart failure (HF). While anticoagulation is effective, only 60% receive it. We aimed at studying the safety of LAAC in HF patients using a national all-payer database.
Methods:
We queried the National Inpatient Sample for the year 2016-2018 for WATCHMAN device insertion using ICD 10 procedure codes. We divided the study population into HF and non-HF groups. Outcomes were compared using appropriate statistical tests, p< .05 was considered significant.
Results:
34 385 LAAC procedures were identified of which 8530 (24.8%) were done in patients with HF. The mean (SD) age of the study population was 76 (7.9) years and 42% were female. There was no difference in mean age between HF and non-HF groups. Our findings indicate that there is no difference in inpatient mortality and cardiac complications between the HF and non-HF groups. However, noncardiac complications including acute kidney injury and respiratory failure were higher in the HF group.
Conclusion:
LAAC appears to be a safe procedure in patients with HF. The study is limited by a short follow up period and long-term follow-up is required before definitive conclusions can be made.
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